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25 Other Ooops… Oh No!... The Wrong Patient was Checked-In, in AHLTA -Unfortunately there Undo -It is not possible to update the Appointment to No-Show After they have been Checked In What to Do?? -First - use AHLTA to Locate the patient that was Checked-In in error and update to Facility Cancel -Use CHCS End of Day (EOD) and locate the Patient Appointment and change the Facility Cancel to No-Show It is understood that the CHCS and AHTLA Appointment Status will not match CHCS is the Source System of Record for all Appointment/Visit for TRICARE Operations Center and Workload Reporting Limit changing the Visit to an ADMIN Visit to current date. If encounter is coded and later changed to ADMIN, this will result in an ADM Encounter Error. It is understood that the CHCS and AHTLA Appointment Status will not match CHCS is the Source System of Record for all Appointment/Visit for TRICARE Operations Center and Workload Reporting Limit changing the Visit to an ADMIN Visit to current date. If encounter is coded and later changed to ADMIN, this will result in an ADM Encounter Error.

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41 Patient Registration Flow DEERS Updates AHLTA Clinical Data Repository DEERS/CHCS Synchronize Patient Data DEERS is considered to be the “gold” standard for Patient Identity and key data elements that uniquely identify a Beneficiary. When a new patient is being added to CHCS, data from DEERS is downloaded into CHCS. CHCS Change Package of April 2011, established New Security Keys to prevent Users from by-passing DEERS matching. Users with the Fileman “&” ampersand key will only be allowed to create new Patient Records, if the patient is found in DEERS, unless they also have the NEW DG ADD PATIENT Security Key that allows them to add Patients to CHCS - NOT Found in DEERS. DEERS is considered to be the “gold” standard for Patient Identity and key data elements that uniquely identify a Beneficiary. When a new patient is being added to CHCS, data from DEERS is downloaded into CHCS. CHCS Change Package of April 2011, established New Security Keys to prevent Users from by-passing DEERS matching. Users with the Fileman “&” ampersand key will only be allowed to create new Patient Records, if the patient is found in DEERS, unless they also have the NEW DG ADD PATIENT Security Key that allows them to add Patients to CHCS - NOT Found in DEERS.

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43 DEERS Address Updates Do not use % * ~ ? [ ] { } in the address field Enter complete Phone Number including Area Code CHCS/DEERS Address Updates: -CHCS requests eligibility data from DEERS, for NEW Registrations -Address information from DEERS is downloaded into CHCS -A date/time stamp is associated with the address update -If the patient is found in DEERS, the DEERS Patient ID is downloaded to the CHCS patient file -When the address is updated on CHCS, DEERS is updated, ONLY IF there is a Enterprise Person ID in CHCS -When DEERS receives update message, it compares the address update date/time to whatever date/time is on file in DEERS. If the message from CHCS isn't "fresher" than the data on file, it is dropped Source: SAIC Fieldservices Informational of November 2004 and New DEERS Release Notes After the initial registration, CHCS does not automatically update address data from DEERS unless the user specifically uses the "Demographics" action on the DEERS Eligibility Request option, and chooses to update the data. User must also have the CHCS DG Reg Sync Security Key to synchronize/download DEERS data elements into CHCS. After the initial registration, CHCS does not automatically update address data from DEERS unless the user specifically uses the "Demographics" action on the DEERS Eligibility Request option, and chooses to update the data. User must also have the CHCS DG Reg Sync Security Key to synchronize/download DEERS data elements into CHCS.

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47 Enrollment Processing Interface between CHCS/DEERS supports TRICARE Managed Care Enrollments for TRICARE Prime MTF Enrollees When key data elements or Sponsor data does not match between CHCS/DEERS, an error or discrepancy will be reported Enrollment data errors potentially impact successful updates: -New Enrollments -Enrollment and PCM Transfers -Family Member Enrollments MTFs are not credited with the enrollment if there is an enrollment error and the enrollment is not valid in DEERS Enrollment errors may result in delays in TRICARE Network Consult/Referrals being processed – impacting Patient Care!

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51 Inpatient Visits Both CHCS and AHLTA will prompt: -(CHCS) Are you from the attending service? No// -(AHLTA) Related to Inpatient Stay?: Allied Health Providers-> Accept CHCS default of “NO” Consulting Providers-> Accept CHCS default of “NO” -The Visit will be a COUNT and assigned to a “B” Level FCC Only the Attending Clinical Staff of the Same Clinical Service should answer “YES” WALK-IN SEARCH CRITERIA Patient: HEALTHE,YOU FMP/SSN: 30/ Clinic: QQQCHCSIITESTBRAGG CLINIC/WAMC ATC Category: Clinic Phone: Appt Type: ACUTE APPT Provider: QQQCHCSIITEST,BRAGGDOCA Duration: Detail Codes: Srv Type: Time Range: 0950 to 0950 Days of Week: Dates: 14 Feb 2010 to 14 Feb This is an inpatient. Are you from the attending service? No//

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52 AHLTA Inpatient Prompt 1.Note: Patient found as InPatient (MEPRS YYYA) 2.Leave Blank 3.Pop Up Message will then be displayed 4.Click No – “the Visit is NOT associated with the inpatient stay…” 5.Visit/Encounter will then be credited to the Assigned Clinic

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55 Inpatient Admissions CHCS is the source system for Inpatient Admissions, Transfers and Dispositions: -Assigns Occupied Bed Days (OBDs) at the Census Hour, to the current Clinical Service -Day of Admission is always equal to an OBD, even if the Admission is less than 24 Hours, unless the patient is a Transfer In and Out the same day -Day of Discharge is not counted as an OBD for Workload or Billing -Current Clinical Service used as the Requesting Location for Inpatient Ancillary Services Inpatient Coding: -ICD-9 Codes used to capture both Diagnosis and Inpatient Procedures -NATO STANAG (2050) for Cause of Injury Coding -Diagnosis Related Grouping (Inpatient CCE – MS-DRG Grouping)

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56 Attending RNDS* Current Attending Provider and Clinical Service used to create Inpatient Professional Services Record (IPSR RNDS*) in CHCS Ambulatory Data Module (ADM) The RNDS* Encounter is used to capture the Inpatient Professional Services of the Attending Provider RNDS* Encounters are completed in ADM: ICD-9 Diagnosis CPT Procedures (Including Evaluation & Management Codes) RNDS* Encounters not completed within 30 days are automatically Cancelled by CHCS RNDS* Encounters will display in AHLTA. Monitor that Providers DO NOT CANCEL RNDS* in AHLTA Recommend that the “Placeholder” be entered for RNDS* RNDS* are NON-COUNT and do not require an E&M Code if there is a CPT Code entered